1 00:00:02,070 --> 00:00:10,230 This is Keith Horton being interviewed by Derek Hockaday, 19th of September, 2004. 2 00:00:10,230 --> 00:00:14,280 Keith, I saw that you were Cambridge based originator. 3 00:00:14,280 --> 00:00:20,470 What made you choose Cambridge rather than Oxford? Happenstance or or definite choice? 4 00:00:20,470 --> 00:00:30,870 Oh, it was so many things that in those days in the 60s were sort of depended on serendipity. 5 00:00:30,870 --> 00:00:42,150 It was simply that a friend of mine at school had applied to Cambridge and I hadn't thought of it. 6 00:00:42,150 --> 00:00:48,120 And we weren't particularly Oxbridge feeding school. 7 00:00:48,120 --> 00:00:51,720 And I thought, well, I've got better and levels in him. 8 00:00:51,720 --> 00:00:59,400 So I just wrote off to Oxford and Cambridge colleges and or groups of colleges, as one did then. 9 00:00:59,400 --> 00:01:06,030 And St. John's accepted me without an interview at St John's Cambridge. 10 00:01:06,030 --> 00:01:16,230 Great. So, I mean, the choice was clearly that it wasn't a question of selecting me, selecting a particular place to go to. 11 00:01:16,230 --> 00:01:19,950 In fact, six of us from the school went to Cambridge that year. 12 00:01:19,950 --> 00:01:28,380 So it was a relatively you have you got any views on the preclinical training, Oxford, the Cambridge at that time? 13 00:01:28,380 --> 00:01:37,800 Well, I mean, I I'm a peculiar beast in this respect, in that I didn't come didn't go into medicine immediately. 14 00:01:37,800 --> 00:01:49,200 I started off doing reading natural sciences, um, and the physiology, of course, with the medicks in those days as part of natural sciences. 15 00:01:49,200 --> 00:01:56,040 But I ended up specialising in it in psychology. 16 00:01:56,040 --> 00:02:01,770 So I did have subjects, experimental psychology, and I ended up doing part to experimental psychology. 17 00:02:01,770 --> 00:02:11,310 And then I was all set to go to I can't remember why now, but wisconson to do a Ph.D. in psychology. 18 00:02:11,310 --> 00:02:22,110 And um, and then we had some lectures from some very charismatic psychiatrists from Forsworn Hospital in Cambridge as part of experimental psychology. 19 00:02:22,110 --> 00:02:30,300 And I just was captivated by this. And it was all around the days of running Lang and, you know, all these sixties thinking. 20 00:02:30,300 --> 00:02:36,340 And it just appealed to me that this this really could be an interesting route to go. 21 00:02:36,340 --> 00:02:46,530 So I went to my college tutor who was a psychologist at Wellford and said to him, I've decided I want to be a psychiatrist. 22 00:02:46,530 --> 00:02:55,860 And he looked at me for a while saying anything and then said, well, you'll have to do medicine, isn't it? 23 00:02:55,860 --> 00:03:01,890 I had no idea. You didn't I mean, know, it was so naive in those days we were there. 24 00:03:01,890 --> 00:03:08,670 And so then he said, well, you have to have it next year in Cambridge to do anatomy qualifying and one or two other things, 25 00:03:08,670 --> 00:03:13,650 which are less outside labs nowadays in Cambridge. And that's how I came in. 26 00:03:13,650 --> 00:03:25,530 So I didn't really have a sense of the preclinical school in Cambridge in those days because I wasn't, you know, in a sense, even part of it. 27 00:03:25,530 --> 00:03:28,110 Experimental psychology was very distinguished. 28 00:03:28,110 --> 00:03:33,270 It was French and there were medicks who were, you know, doing their first two years and then a third year in that. 29 00:03:33,270 --> 00:03:45,870 Yes, John Oxford did. Yes. And my year was Colin Blakemore Ruddock, who then became head of the commission on John Teesdale, 30 00:03:45,870 --> 00:03:53,790 who was ended up working here, very distinguished, uh, clinical psychologist. 31 00:03:53,790 --> 00:03:58,680 And so it was tremendous and really inspiring. 32 00:03:58,680 --> 00:04:11,250 And actually, I felt equipped me very well to Tickie from my later career when I got into research because it was so experimentally based, 33 00:04:11,250 --> 00:04:17,940 whereas of course, with a lot of the clinical medicine was not much more feeding it with facts and gender. 34 00:04:17,940 --> 00:04:22,710 Yeah. And so on to then Oxford were looking for Cambridge people at the time. 35 00:04:22,710 --> 00:04:27,210 I mean, did you have difficulty getting into the Oxford Clinical School? 36 00:04:27,210 --> 00:04:37,140 No, I didn't. Well I did. I was accepted so I said, well I tried remarkably. 37 00:04:37,140 --> 00:04:44,130 There are only three of us from Cambridge. Our intake in those days, of course, it was when we had the split six months intake, Oxford, 38 00:04:44,130 --> 00:04:55,440 Cambridge and the mind maintains eleven million students, three of us, I think three of us from Cambridge. 39 00:04:55,440 --> 00:05:00,010 So it didn't I didn't seem to have difficulty from. 40 00:05:00,010 --> 00:05:04,390 And how your clinical student goes, I love them, I mean, 41 00:05:04,390 --> 00:05:11,590 I thought we were incredibly lucky in the sense of but I guess some people say, well, it was far too small there. 42 00:05:11,590 --> 00:05:18,040 I think there were 63 students in the medical school, the political school, when I arrived. 43 00:05:18,040 --> 00:05:29,020 But because of that, I think we had extremely good relationships with, you know, um, teachers and and so on. 44 00:05:29,020 --> 00:05:41,020 And somehow we managed to mount a fantastic rugby team with that small number, although it was supplemented by various people on the staff. 45 00:05:41,020 --> 00:05:48,700 And the medical school was just a happy place. And I felt I was so lucky to be in Oxford. 46 00:05:48,700 --> 00:05:56,410 And of course, the buildings in those days were the medical school buildings were lovely, you know, which is what is now green in college. 47 00:05:56,410 --> 00:06:03,640 And so I, I, I find it a very great time. 48 00:06:03,640 --> 00:06:07,960 And you never wavered in your wish to be a psychiatrist? No, I didn't. 49 00:06:07,960 --> 00:06:15,700 I mean, I was considered a very odd fish because psychiatry hopefully less so these days, 50 00:06:15,700 --> 00:06:22,810 but in those days was regarded as a somewhat odd speciality, attracting old people. 51 00:06:22,810 --> 00:06:27,530 And yet here was someone who was playing rugby, cricket, various other sports. 52 00:06:27,530 --> 00:06:31,420 And one of the lads still wants to be a psychiatrist. 53 00:06:31,420 --> 00:06:34,520 So people couldn't quite fit it. 54 00:06:34,520 --> 00:06:38,200 But I didn't I didn't waiver at all. 55 00:06:38,200 --> 00:06:48,280 And how did you what did you think of your Time Warner and the other place as a student doing the psychiatrist bertelmann about? 56 00:06:48,280 --> 00:06:54,880 Well, yes, we we didn't spend a bit of time with Bertie Mandelbrot. 57 00:06:54,880 --> 00:07:00,940 It was I mean, it was all very odd over a little more. 58 00:07:00,940 --> 00:07:08,620 I mean, they were running community therapy, which to me seemed bedlam. 59 00:07:08,620 --> 00:07:21,130 And I mean, they when really we came to the one foot and had a month here that, you know, I think we got much more systematic teaching and so on. 60 00:07:21,130 --> 00:07:29,530 And it came across people who I sort of had more respect for in the sense of their approach to psychiatry, 61 00:07:29,530 --> 00:07:36,880 which fits in more with, you know, where I come from in experimental psychology and and so on. 62 00:07:36,880 --> 00:07:40,210 So did you and you have a month of psychiatry in those days? 63 00:07:40,210 --> 00:07:46,150 I'm pretty sure we only had a month. Yeah. And you had a GP attachment? 64 00:07:46,150 --> 00:07:53,620 I did. Did you enjoy that? I did. And I did it out of Atterberry. 65 00:07:53,620 --> 00:07:57,550 And I did this every time I drive through. And I remember that fondly. 66 00:07:57,550 --> 00:08:02,710 And, you know, it's good. And knowing you were going to do psychiatry. 67 00:08:02,710 --> 00:08:08,200 So how seriously did you take the medicine and surgery and is, you know, whatever? 68 00:08:08,200 --> 00:08:15,910 Well, I wouldn't have said I was the most dedicated student. 69 00:08:15,910 --> 00:08:19,600 I have to say surgery did not attract me at all. 70 00:08:19,600 --> 00:08:28,630 And so I think I probably did the minimum to get by with surgery. 71 00:08:28,630 --> 00:08:35,420 Of course, I have to do a surgical house job, and I do Pennypacker, you know, 72 00:08:35,420 --> 00:08:42,040 the neurologist was here then and he helpfully arranged me to do a neurosurgical house job so I could get, 73 00:08:42,040 --> 00:08:46,330 you know, I could bring him in the direct entry to the brain. 74 00:08:46,330 --> 00:08:55,170 Yeah, I was Scandrick. So I went to Manchester and did a house job in neurosurgery, which was extremely Jefferson. 75 00:08:55,170 --> 00:08:59,080 No, no, don't worry. 76 00:08:59,080 --> 00:09:05,540 I've forgotten the name. Dustin was one of the consultants and the other chaps name of them. 77 00:09:05,540 --> 00:09:09,580 I know Jefferson had left, but that was. 78 00:09:09,580 --> 00:09:14,200 But there was Ted Buckley was there. Yes. Who said he was the senior registrar. 79 00:09:14,200 --> 00:09:19,030 So that was. And was that before or after your job? 80 00:09:19,030 --> 00:09:28,810 That was my it was after I had my house job, first house job with Leo Warner down at the county road and with cousins below. 81 00:09:28,810 --> 00:09:33,100 And he met him once and he was in America. 82 00:09:33,100 --> 00:09:40,920 I think he's somewhere else. Yes. But you didn't get attracted to the secretary of old age psycho geriatrics, which is a special dinner? 83 00:09:40,920 --> 00:09:53,620 No, no. I didn't know that side of psychiatry didn't track me, knows I was more interested in adults, 84 00:09:53,620 --> 00:10:01,360 young adults, particularly the sort of neurotic end of the spectrum of psychiatry. 85 00:10:01,360 --> 00:10:08,420 Although, you know, I embrace the broader severe mental illness, schizophrenia and so on, 86 00:10:08,420 --> 00:10:14,260 aspects of the enjoy that, but I wasn't attracted really to psychiatric drugs. 87 00:10:14,260 --> 00:10:19,570 So then when you're done, your house shows what happened then. Then? 88 00:10:19,570 --> 00:10:27,630 Well, I was up in Manchester at that stage doing the neurosurgical job and I really wanted to come back to Oxford. 89 00:10:27,630 --> 00:10:33,040 I loved Oxford and I'd been here ever since more or less. 90 00:10:33,040 --> 00:10:38,830 So I applied for it was a locum job, came up with Seymour Spencer. 91 00:10:38,830 --> 00:10:51,880 And so I applied for that. And I came in September and there was plans being made them for a proper training scheme in psychiatry. 92 00:10:51,880 --> 00:10:58,360 And I was lucky enough to be one of the first trainees on that scheme. 93 00:10:58,360 --> 00:11:02,620 So it was a proper three year. So this is about two. 94 00:11:02,620 --> 00:11:12,520 Oh, gosh. Um, because you're qualified, you know, so much earlier, much earlier at 69 or so, I got my dad. 95 00:11:12,520 --> 00:11:18,400 So that's 70. So this would have been 71. Yeah, simply 132. 96 00:11:18,400 --> 00:11:27,670 Yeah. So I came to with Seymour Spencer and then I got on the training scheme and and had they funded the chair by then. 97 00:11:27,670 --> 00:11:35,710 Yes. Michael. And was already here. He came in 1968. So he was already here. 98 00:11:35,710 --> 00:11:40,480 And there was, you know, the exciting things going on with the new department. 99 00:11:40,480 --> 00:11:50,530 And what was for me was very special was I got involved with research more or away and got involved the project with David Juliar, 100 00:11:50,530 --> 00:11:58,430 John Bancroft and the gaffer's involved in looking at psychiatry in the general hospital. 101 00:11:58,430 --> 00:12:04,840 So it was it was it was screening medical patients down at the old, you know, 102 00:12:04,840 --> 00:12:13,360 where I am for psychiatric disorder and actually ended up with a seminal research paper in the BMJ. 103 00:12:13,360 --> 00:12:19,930 It was the first one of its kind when the country was beginning. 104 00:12:19,930 --> 00:12:25,180 And Richard Matt was very keen on that thread. Yeah. And I always wonder the bit. 105 00:12:25,180 --> 00:12:27,690 I mean, here these guys, they're real. 106 00:12:27,690 --> 00:12:35,730 There's not surprising if they're a bit of centre and how the what is the relationship between that and what they're like when they're better, 107 00:12:35,730 --> 00:12:47,590 they get better? Well, I mean, I think the erm obviously the relationship between physical illness and mental illness or mental problem, 108 00:12:47,590 --> 00:12:54,040 psychological, psychiatric and psychological problems is complex. You know, it's it's two way. 109 00:12:54,040 --> 00:13:00,220 There's other factors that can play, such as, you know, the treatments for physical illness, of course, 110 00:13:00,220 --> 00:13:10,090 can have some can have psychological psychiatric effects, as can the effects of psychiatric drugs. 111 00:13:10,090 --> 00:13:14,020 I think one of the important things we discovered, which we didn't know then, 112 00:13:14,020 --> 00:13:20,980 was that having a psychiatric disorder, we don't usually talk about depression here. 113 00:13:20,980 --> 00:13:27,490 Anxiety has been more pronounced, seems to have an influence on the prognosis of the physical disorder. 114 00:13:27,490 --> 00:13:28,810 And it's been shown very, 115 00:13:28,810 --> 00:13:38,350 very clearly for cardiac people who had cardiac erm phones and those who had depression have a far greater mortality subsequently. 116 00:13:38,350 --> 00:13:44,860 So there's there's an important relationship there. 117 00:13:44,860 --> 00:13:52,900 And in some patients, when their physical illness improves, the psychiatric problems will often they won't. 118 00:13:52,900 --> 00:13:59,230 And of course you have to look back at vulnerability factors as family history and so on and so forth. 119 00:13:59,230 --> 00:14:04,340 And these all come to play on in terms of the prognosis of those. 120 00:14:04,340 --> 00:14:09,340 So this is the opposite of the placebo effect. 121 00:14:09,340 --> 00:14:19,630 Yes, I suppose you could say, because always feel that the placebo effect is getting the patient's autonomic system in an ideal condition. 122 00:14:19,630 --> 00:14:22,060 And of course, we can't measure the ordinary knowing. 123 00:14:22,060 --> 00:14:27,710 Great, you know, it's just a dream that we've been lovely in these patients to be able to measure that somehow. 124 00:14:27,710 --> 00:14:32,860 Yes. Yes. I mean, we really still don't know how placebos work. 125 00:14:32,860 --> 00:14:40,660 And yet, you know, we know for sure drug trials that, for example, in my field, in antidepressant treatment of depression, 126 00:14:40,660 --> 00:14:45,580 you get about 30 percent response with the seaburg and the doctors, the placebo group and the doctor. 127 00:14:45,580 --> 00:14:49,420 Of course, the way it's delivered this patient is really important. 128 00:14:49,420 --> 00:14:56,900 So when did you, as it were, or maybe you didn't, did you withdraw from clinical work to write a thesis work on and. 129 00:14:56,900 --> 00:15:08,290 No, I didn't. M.D., um. And was able to do the my research in parallel with my clinical work. 130 00:15:08,290 --> 00:15:13,630 By that time I'd become a lecturer and in the department here. 131 00:15:13,630 --> 00:15:18,430 And so I was and Michael Gallagher was very protective. 132 00:15:18,430 --> 00:15:24,340 I mean, lots and lots and lots of, you know, skills. 133 00:15:24,340 --> 00:15:29,860 And one was that he ensured that his unlike in many other departments, 134 00:15:29,860 --> 00:15:38,840 that is an academic staff really did have time to do proper research and that the clinical work was very circumscribed. 135 00:15:38,840 --> 00:15:48,700 So that was very helpful. So I was able to do an M.D. in parallel with Michael Girdler, in a sense, had a blank sheet right on. 136 00:15:48,700 --> 00:15:53,590 But of course, he was actually demoted and he is really the guy who built this place up. 137 00:15:53,590 --> 00:15:56,890 Is that correct? Absolutely. 138 00:15:56,890 --> 00:16:11,770 And I mean, as you know, Michael, incredibly high standards, which at times, of course, put pressure on trainees and and so on. 139 00:16:11,770 --> 00:16:17,920 But I mean, the standards, he said, I think were most things were fantastic. 140 00:16:17,920 --> 00:16:21,250 And he had very close, very high standards in research. 141 00:16:21,250 --> 00:16:27,970 And yes, absolutely one of the reasons for the success of this department as being those high standards, 142 00:16:27,970 --> 00:16:37,600 he said, but also the fact that he integrated biological and more psychological, 143 00:16:37,600 --> 00:16:40,270 even psychosocial aspects of psychiatry, 144 00:16:40,270 --> 00:16:48,790 he was able to embrace those within the department or some other departments can't have gone down the biological route or less. 145 00:16:48,790 --> 00:16:55,120 So the more psychological route, the great success here was that he was able to, you know, 146 00:16:55,120 --> 00:17:03,250 bridge across those that always been the tradition because Jeffrey Harris worked with Robert. 147 00:17:03,250 --> 00:17:06,940 And then I think the unit came here. Did it? That's right. 148 00:17:06,940 --> 00:17:14,080 They had a unit a little more for a while. And and then it then it moved here. 149 00:17:14,080 --> 00:17:25,420 And now we have a full year in neurosciences unit with three or four classes because early days, David Graham Smith sort of took over that aspect. 150 00:17:25,420 --> 00:17:32,320 That's right. And did you see him or. I didn't know? Well, I wasn't really involved much with that side. 151 00:17:32,320 --> 00:17:44,320 Some of my colleagues went and trained with him because I think it was mainly based on the practise, but they were doing psychopharmacology research. 152 00:17:44,320 --> 00:17:51,790 And I think people like Phil Cowan, who's here now, and others, they trained with him. 153 00:17:51,790 --> 00:17:56,020 And so we felt the influence of that in the department. Yeah. 154 00:17:56,020 --> 00:18:02,860 So what was your M.D. on my India on self-harm or attempted suicide? 155 00:18:02,860 --> 00:18:07,900 How you got onto that by then? I got onto that by then, yes. 156 00:18:07,900 --> 00:18:14,290 My boss, one of my bosses during my psychiatry training was John Bancroft. 157 00:18:14,290 --> 00:18:21,130 And he this was during the times when the General Hospital was just beginning to 158 00:18:21,130 --> 00:18:26,630 experience increasing numbers of patients coming in with overdoses and self injuries. 159 00:18:26,630 --> 00:18:30,790 I mean, I think the rates in Oxford quadrupled over ten years. 160 00:18:30,790 --> 00:18:37,600 And Michael Gowda said to John Bancroft is his reader. 161 00:18:37,600 --> 00:18:41,950 Would you go and try and find out what's going on? Because we couldn't. 162 00:18:41,950 --> 00:18:48,970 You can't you couldn't provide a decent service for these people going in after hours and trying to see patients and they'd left and so on. 163 00:18:48,970 --> 00:18:54,310 And so he wisely set up a research programme and said, well, let's find out more about it, 164 00:18:54,310 --> 00:18:58,420 which, you know, is always a good way of going about things. 165 00:18:58,420 --> 00:19:04,030 And then a clinical service developed out of that work. 166 00:19:04,030 --> 00:19:09,880 The Bones unit developed out of that the on psychiatry service. 167 00:19:09,880 --> 00:19:17,750 And he got Department of Health Research funding and said to me, would you like to come and do some work in this area? 168 00:19:17,750 --> 00:19:25,630 And I thought, well, probably have a short life, last life working in suicide research, but I would do it for a couple of years. 169 00:19:25,630 --> 00:19:34,690 And so I worked on the balance in the West that I had developed that that because that was very useful. 170 00:19:34,690 --> 00:19:38,450 Then Dennis Scarce was there. He was a great guy. Yes. Yes. 171 00:19:38,450 --> 00:19:47,140 Dennis was. What was he working on? Well, he did a range of things, but he got he got involved in general hospital liaison psychiatry. 172 00:19:47,140 --> 00:19:55,780 Again, he worked a lot on women's problems, problems related to depression. 173 00:19:55,780 --> 00:19:59,880 Um, psychological. Psychiatric. 174 00:19:59,880 --> 00:20:10,780 Various gynaecological problems, as Richard may have worked on, road traffic accidents work on the psychological impacts of road traffic accidents, 175 00:20:10,780 --> 00:20:14,800 but they were sort of, you know, working quite closely, closely together. 176 00:20:14,800 --> 00:20:18,220 And of course, Dennis was a great mentor in turn. 177 00:20:18,220 --> 00:20:30,550 I mean, he he he got an English degree or languages before he made the and so he was a great writer. 178 00:20:30,550 --> 00:20:36,250 And he was one of the reasons really for the success of the Oxford textbook. This country beautifully written. 179 00:20:36,250 --> 00:20:42,460 But I have to say, he was a tough act to write with because when I went through so many draughts, 180 00:20:42,460 --> 00:20:53,890 I think when people went through the 30 draughts, but it was all about the common cause of death and so on. 181 00:20:53,890 --> 00:20:57,550 Now, when did the first edition of that come out, roughly, would you say? 182 00:20:57,550 --> 00:21:09,880 Because, um. Oh, gosh, I you know, I think I well, I thought it was during the 80s and I said yes, because Michael Geldof has been involved in that. 183 00:21:09,880 --> 00:21:18,340 Oh, yes. Yeah, it was it was Michael Dennis. And I think Richard maybe to a lesser extent on the stage, but, you know, 184 00:21:18,340 --> 00:21:23,680 no Michael, go to war and always heard he was really keen on punctuality is said. 185 00:21:23,680 --> 00:21:30,940 But otherwise I would imagine he was a and even when annoyed or not. 186 00:21:30,940 --> 00:21:35,320 Yes. I think there were times when he annoyed. 187 00:21:35,320 --> 00:21:40,930 I mean, he did have you know, he was a stickler for timekeeping. 188 00:21:40,930 --> 00:21:46,300 He just couldn't stand sloppy thinking. 189 00:21:46,300 --> 00:21:50,770 And he comes from the Maudsley where, you know, the training there had been so rigorous. 190 00:21:50,770 --> 00:22:02,500 And his approach to patient assessment was I mean, I had to say, I mean, it's far better than one of the nurses now being practised. 191 00:22:02,500 --> 00:22:09,490 And, you know, for example, if you hadn't spoken to the relatives and got a full family history, you know, you hadn't done your job. 192 00:22:09,490 --> 00:22:16,120 I mean, even if you lived in the suburbs. 193 00:22:16,120 --> 00:22:20,200 So he, you know, and it was it was great. 194 00:22:20,200 --> 00:22:28,000 And people think, you know, now refer back to those standards and say, gosh, you know, that's what we should really aspire to. 195 00:22:28,000 --> 00:22:34,100 Oh, that's a great I mean. Yeah, yeah. So now your thesis, would you have taken that? 196 00:22:34,100 --> 00:22:38,860 We wouldn't have had a word processor and. No, no. I mean, that's the I mean, it's unbelievable now isn't it. 197 00:22:38,860 --> 00:22:50,270 I mean, I had a secretary I didn't know I had a secretary who typed you wrote it in and then of course it went through many draughts, 198 00:22:50,270 --> 00:22:54,820 several draughts, including tables, and they all had to be retired. 199 00:22:54,820 --> 00:23:04,480 I mean, it's just extraordinary. And, you know, when I tell junior researchers now, I just can't get at them. 200 00:23:04,480 --> 00:23:13,930 And who examined you? Um, um, I was examined by a professor in Bristol Gethard. 201 00:23:13,930 --> 00:23:17,950 Morgan, right. Yeah. I never actually had a face to face. 202 00:23:17,950 --> 00:23:25,120 Vivir know it was dumb. Oh that's very good. Well hi. 203 00:23:25,120 --> 00:23:32,180 And did you, I mean did you see the comments. Um well I think it was just a general positive comment. 204 00:23:32,180 --> 00:23:35,500 You they have to write something. That's all I've got for you. So. Yes. 205 00:23:35,500 --> 00:23:42,700 Yeah great. And I mean, did you in any way change direction after that or did you when did you become a consultant? 206 00:23:42,700 --> 00:23:48,100 What? Well, I spent a long while in the academic department. 207 00:23:48,100 --> 00:23:59,770 I think I joined the department in nineteen seventy four and I was a lecturer and then clinical tutor, 208 00:23:59,770 --> 00:24:06,250 which here is the person who organises people's student training. 209 00:24:06,250 --> 00:24:16,030 Very good. So I did like 12 years in that, you know, I had two lecturers jobs, then became a technical tutor. 210 00:24:16,030 --> 00:24:24,490 And so effectively I was at the level of senior registrar for around twelve years, which is now extraordinary. 211 00:24:24,490 --> 00:24:36,520 You couldn't do it now. But for me it was wonderful because I, I developed a full you know, what was quite a research programme. 212 00:24:36,520 --> 00:24:46,210 I was doing clinical work, so I was acting as a consultant, running an inpatient unit, an outpatient and outpatient a week. 213 00:24:46,210 --> 00:24:59,600 Oh, well, once I when I got to be a consultant, which is 84, we were dealing with a population of something like 200. 214 00:24:59,600 --> 00:25:11,000 5000, so we had a chunk of the city, I think, of the city, I think a third and west, so she'll be here in those days. 215 00:25:11,000 --> 00:25:17,350 So I like I know how many outpatients a week, multiple sessions, sessions. 216 00:25:17,350 --> 00:25:26,120 Oh, I see. Um, I think it was two or three, but we had a very big inpatient unit, so we had 25, 217 00:25:26,120 --> 00:25:37,550 although it went down to 23 inpatient beds and I was the sole consultant. But I had I did have a really good most of the time junior medical team. 218 00:25:37,550 --> 00:25:43,370 And Michael, because I was a, you know, university senior lectureship, 219 00:25:43,370 --> 00:25:54,600 then ensured that I had plenty of senior registrar times and lecturers would come and work with us in addition to the NHS senior registrar. 220 00:25:54,600 --> 00:26:01,700 So we had a big medical team. And and by that sort of towards the end of your time as a clinical tutor, 221 00:26:01,700 --> 00:26:05,720 how long did the medical students come to you for whether they were then coming for eight weeks? 222 00:26:05,720 --> 00:26:12,740 Yeah, I guess. Yeah. Yeah. One of the things Michael did say earlier when I first arrived in the department, 223 00:26:12,740 --> 00:26:22,100 we used to have weekly departmental meetings just as the, you know, team sort of in the department, which is quite small. 224 00:26:22,100 --> 00:26:27,230 And most of those were focussed on how to improve teaching for students. 225 00:26:27,230 --> 00:26:38,480 And I think it's fair to say that the as a result of that, the second I think the teaching the students got, I think was a very high standard. 226 00:26:38,480 --> 00:26:45,380 And I think I you know, it was a sort of parallel with what they got an orthopaedic surgeon who was very well organised. 227 00:26:45,380 --> 00:26:51,290 And we had a day, for example, a day formal teaching per week. 228 00:26:51,290 --> 00:26:55,580 Um, and and they still do this. 229 00:26:55,580 --> 00:26:57,740 And so that tradition has continued. 230 00:26:57,740 --> 00:27:05,870 And I think I'm not you know, and we've had to battle, of course, against prejudice, against psychiatry and and so on and so forth. 231 00:27:05,870 --> 00:27:16,070 And I think we do have to make special efforts to teach and, you know, to counter some of the negative attitudes some of the students come with. 232 00:27:16,070 --> 00:27:23,660 And I think most of them really enjoy it. And the impression I got then your relationships with the university, I mean, 233 00:27:23,660 --> 00:27:29,540 both the clinical students and everybody else, because they always used to be said that the world would go first. 234 00:27:29,540 --> 00:27:33,680 And baby, I mean, what I did, I go on. I don't know. 235 00:27:33,680 --> 00:27:40,730 No, I think the I mean, at one time this was the the student, you know, university members, 236 00:27:40,730 --> 00:27:47,960 whether they be a students or staff, would come to and we had a very different psychiatric service then. 237 00:27:47,960 --> 00:27:56,510 So they would come to the ward further. It was a little more tender to deal with, you know, the sort of general more with the general population. 238 00:27:56,510 --> 00:28:07,280 When we all became when it became sex, control became secularised. In other words, consultants dealt with particular areas and particular GP groups. 239 00:28:07,280 --> 00:28:12,500 And that all changed, although there was still a tendency for university staff to come here. 240 00:28:12,500 --> 00:28:19,070 No, I mean, we had a psychologist here, Mae Davidson, who was there, and she'd worked with several burns and, 241 00:28:19,070 --> 00:28:26,450 you know, in the ward and things on the fly, fighter pilots and so on. 242 00:28:26,450 --> 00:28:30,560 But she she took a lot of students under her wing. 243 00:28:30,560 --> 00:28:35,870 And that was part of the reason that so many, you know, actually took their exams here. 244 00:28:35,870 --> 00:28:40,640 Um, and, yes, I think we had more firsts. 245 00:28:40,640 --> 00:28:47,960 I think we were top of the unofficially. 246 00:28:47,960 --> 00:28:58,040 And do you think the phenomenon of undergraduate suicide death was a push towards Oxford concentrating on suicide, 247 00:28:58,040 --> 00:29:01,310 or was it more that and you said all thanks, 248 00:29:01,310 --> 00:29:12,170 but no, I think it was more what at that time was what was happening with regard to attempted suicide or self-harm. 249 00:29:12,170 --> 00:29:20,300 That was the driving force. So it was it was in a sense driven by clinical pressures and needs. 250 00:29:20,300 --> 00:29:27,650 But there was, of course, the problem of student suicides and undoubtedly Oxbridge had, 251 00:29:27,650 --> 00:29:34,430 you know, reading the research papers in the 40s, 50s, some extent. 252 00:29:34,430 --> 00:29:40,070 The 60s did have very elevated rates of suicide compared with young people in general population forty. 253 00:29:40,070 --> 00:29:45,800 That's no longer true. Right. And we've done a lot of work on that since the mid seventies. 254 00:29:45,800 --> 00:29:50,790 And, you know, student deaths, of course, 255 00:29:50,790 --> 00:30:00,000 the tragedy is that it looks pretty clear that the rates aren't higher at Oxford and Cambridge than in the general population. 256 00:30:00,000 --> 00:30:07,440 I'm not sure about other universes that not many of us collect very good data, which is extraordinary, really. 257 00:30:07,440 --> 00:30:13,980 Any idea why that was going on in the 50s? Well, I think there were a number of factors. 258 00:30:13,980 --> 00:30:27,540 I mean, I think the gender ratio didn't help. I mean, the huge excess of males, I think it probably had to do with the post-war, 259 00:30:27,540 --> 00:30:34,170 you know, the gender or the war generation and people not talking about problems. 260 00:30:34,170 --> 00:30:44,100 Not a lot of young males still have difficulties were not as bad as then, I think attitudes towards mental illness and the availability of gas. 261 00:30:44,100 --> 00:30:54,210 And, of course, we had gas fires. I mean, one of the things we've learnt in suicide research is that the availability of method, 262 00:30:54,210 --> 00:30:57,900 dangerous methods, is crucial to influencing suicide rates. 263 00:30:57,900 --> 00:31:08,220 And that's your campaign against paracetamol? Well, it was about, you know, smaller packs of paracetamol and particularly the work we did on proximal, 264 00:31:08,220 --> 00:31:18,180 which led to its withdrawal because we discovered that one in five fatal overdoses involved that one drug. 265 00:31:18,180 --> 00:31:29,300 And, you know, it was work we did that stimulated the regulatory agency, the MHRA, to investigate it and then withdraw it. 266 00:31:29,300 --> 00:31:35,130 And, you know, I guess for me, that's one of the most rewarding things I've been involved in. 267 00:31:35,130 --> 00:31:40,770 I had to present the research to the research findings to the European Medicines Agency, 268 00:31:40,770 --> 00:31:48,450 and that led to an EU ban throughout the EU and the states and territories and the states of. 269 00:31:48,450 --> 00:32:00,120 Yeah, but they, of course, found another reason for doing so. I think cardio cardiac toxicity was a suicide and suicide. 270 00:32:00,120 --> 00:32:03,600 Obviously, either group can make a mistake, you know, get the wrong group. 271 00:32:03,600 --> 00:32:09,540 But do you fundamentally regard them as different phenomena or are they going to regard them as very overlapping? 272 00:32:09,540 --> 00:32:20,010 Yes, and for for various reasons. One of them just sort of touched on in the sense, you know, what method happens to be in the general public. 273 00:32:20,010 --> 00:32:26,600 You know, safety comes to taking overdoses of tablets are very, very ignorant. 274 00:32:26,600 --> 00:32:31,830 That's not the right term. But I just don't know. I'm aware of time. 275 00:32:31,830 --> 00:32:40,200 As I always remember, someone, an elderly woman presenting was taking six penicillin capsules and she was highly suicidal. 276 00:32:40,200 --> 00:32:49,290 And she said, well, I've been told that one kills millions of bacteria. You may you know, it was really quite impressive. 277 00:32:49,290 --> 00:32:55,260 So it's you know, it is often a chance. 278 00:32:55,260 --> 00:33:02,820 The other thing we know is that the suicidal ideas are often very fleeting. 279 00:33:02,820 --> 00:33:09,080 I mean, bizarrely, people have interviewed people who died after jumping off the Golden Gate, 280 00:33:09,080 --> 00:33:12,570 I'm sorry, or jumping off the Golden Gate Bridge another. 281 00:33:12,570 --> 00:33:19,140 And I'd done it with interviewing someone in the states who can put another bridge in Boston. 282 00:33:19,140 --> 00:33:26,940 And they these people, what they say is once they done jumps, 283 00:33:26,940 --> 00:33:33,480 they talk about the ambivalence of doing it and then once they jump their first thought of survival. 284 00:33:33,480 --> 00:33:36,640 And, you know, that really is a telling message. 285 00:33:36,640 --> 00:33:45,930 So the whole thing is, you know, has a lot of ambivalence to suicidal ideas often, you know, very brief. 286 00:33:45,930 --> 00:33:51,450 OK, there are some people who are absolutely determined to die and and so on and so forth. 287 00:33:51,450 --> 00:33:57,480 But I think, you know, there is a big overlap. So I see it as a spectrum sort of spectrum. 288 00:33:57,480 --> 00:34:05,460 You know, now the people that, you know, generalisations were giving barbiturates to those people, 289 00:34:05,460 --> 00:34:09,960 how much backwash did you get up here with addictions and. 290 00:34:09,960 --> 00:34:19,860 Oh, not so much with addiction. So there was some psyche with the I mean, the barbiturates were sort of being phased out really early in my career. 291 00:34:19,860 --> 00:34:21,420 So I wasn't so aware of that. 292 00:34:21,420 --> 00:34:32,280 But certainly with minor tranquillisers and those were the main drugs used for overdose at that time because it's no longer true. 293 00:34:32,280 --> 00:34:37,320 And we were certainly seeing people who were dependent. 294 00:34:37,320 --> 00:34:41,430 Um, but then the message went out to primary care. 295 00:34:41,430 --> 00:34:51,180 I always remember a paper in the BMJ don't prescribe pills for personal problems, and it was all about tranquilise. 296 00:34:51,180 --> 00:34:56,820 And this country got the message and the prescribing went right down. 297 00:34:56,820 --> 00:35:06,270 And there's research showing clearly how. Impacted on well, obviously on addictions, but the overdose rate of those drugs went right, 298 00:35:06,270 --> 00:35:11,100 went right down, whereas in other countries that hasn't happened in Ireland, for example, they still have. 299 00:35:11,100 --> 00:35:17,280 And that's true is that the GP's have a Renai because you often hear about they have no idea. 300 00:35:17,280 --> 00:35:21,360 Tranquilise, I really got the message on that. So what do they give people? 301 00:35:21,360 --> 00:35:30,300 Um, well, they admit that if they give tranquilise them and give them for no longer than two weeks, they're pretty strict about it. 302 00:35:30,300 --> 00:35:39,310 Or hypnotics, obviously something you need long term treatment and they talk to them or. 303 00:35:39,310 --> 00:35:43,380 Sure. So how much time did you spend abroad? 304 00:35:43,380 --> 00:35:46,860 America times in America. 305 00:35:46,860 --> 00:35:55,260 Where were strictly visits? I mean, I think over on a a month trip, mainly for the teaching of medical students. 306 00:35:55,260 --> 00:36:03,690 But I spent I spent four months in the Netherlands. 307 00:36:03,690 --> 00:36:08,460 I had a visiting professorship at Leiden University, which is a wonderful place. 308 00:36:08,460 --> 00:36:16,830 I really enjoyed that. It was really important as a break. Alex Gatherer was the in charge of consultants in those days. 309 00:36:16,830 --> 00:36:24,660 And I always remember going, lovely man. I remember going to him and saying, I've got this invitation. 310 00:36:24,660 --> 00:36:33,030 And, you know, there were complications about how much income, how much they were going to give me and quite match up to my salary here and there. 311 00:36:33,030 --> 00:36:39,410 And I always remember saying, Keith, let's start from the principle we're working on. 312 00:36:39,410 --> 00:36:42,090 You're going. Yes. And it was fantastic. Yes. 313 00:36:42,090 --> 00:36:48,540 You know, whereas I don't know I don't think consultants I mean, because I was then an NHS consultant work. 314 00:36:48,540 --> 00:36:55,380 But, you know, with running Renninger being able to run the research programme, I didn't have the consultants these days get that sort of it. 315 00:36:55,380 --> 00:37:01,980 And then I spent time in New Zealand visiting position there. 316 00:37:01,980 --> 00:37:05,790 But yeah, but there is a link to suicide or separate. 317 00:37:05,790 --> 00:37:14,760 Um, well, that the New Zealand one was in the sense I was mainly giving lectures around suicide. 318 00:37:14,760 --> 00:37:24,360 The one in Leiden was more general and I was doing a lot of teaching of trainees there, 319 00:37:24,360 --> 00:37:28,350 which was interesting because I couldn't speak the language, but they all speak. Yeah, in English. 320 00:37:28,350 --> 00:37:37,020 But when it came to interviewing patients, I'd have to have a one way screen and I have somebody with me translating. 321 00:37:37,020 --> 00:37:42,240 Somebody else would interview the patients and somebody else would translate. So it was an interesting way of teaching. 322 00:37:42,240 --> 00:37:50,010 But no, it was more general psychiatry and I was doing work then still in general liaison psychiatry. 323 00:37:50,010 --> 00:37:53,850 So we were doing a lot of work on chronic fatigue syndrome at that time. 324 00:37:53,850 --> 00:38:03,360 I think we did some of the original work on that condition here and in the first round, the first psychological therapy trial on that. 325 00:38:03,360 --> 00:38:07,900 And what was your sort of outcome as to its pathogenesis? 326 00:38:07,900 --> 00:38:17,280 OK, well, I you know, we took the view. I mean, of course, as you know, there's tremendous controversy and it goes on about what caused it. 327 00:38:17,280 --> 00:38:26,280 I mean, we took a sort of rather pragmatic approach, which was here's a condition which is disabling. 328 00:38:26,280 --> 00:38:37,590 We don't really understand what factors cause it, uh, it may be due to, you know, a range of of of factors. 329 00:38:37,590 --> 00:38:45,180 But one thing is important is the psychological reaction to whatever's going on that seems to make things worse. 330 00:38:45,180 --> 00:38:52,290 And I mean, that seemed quite clear. And therefore, we adopted a rehabilitation model. 331 00:38:52,290 --> 00:39:01,980 Um, namely, what can one do with psychological therapy to try and help get getting people going, 332 00:39:01,980 --> 00:39:10,590 getting them to change their attitudes, to live with it in a sense. And, uh, um, and rehabilitate. 333 00:39:10,590 --> 00:39:20,780 And of course, I mean, that attracted enormous objection from people who believe in me. 334 00:39:20,780 --> 00:39:32,040 You know, the other term, chronic fatigue syndrome. I was a benign myalgic encephalomyelitis and the hate campaign. 335 00:39:32,040 --> 00:39:39,150 We experienced some of it against people who have been trying to help people with the psychology is unbelievable. 336 00:39:39,150 --> 00:39:40,500 Absolutely unbelievable. 337 00:39:40,500 --> 00:39:48,960 I mean, Simon Wesley, who's suicidal, Wesley, now now present the Royal College psychiatrist who was doing similar work in Kings. 338 00:39:48,960 --> 00:39:52,170 I mean, he had he had death threats. I mean, 339 00:39:52,170 --> 00:39:59,500 and to the extent that he'd go to conferences in the States and people wouldn't want to go out to dinner with him because they thought he might be. 340 00:39:59,500 --> 00:40:05,020 It might be a risk. I mean, he's had to move out of the area, the streets were against it, 341 00:40:05,020 --> 00:40:10,570 against the like, and it wasn't states, it was the it was this these people which are, 342 00:40:10,570 --> 00:40:19,660 you know, this country, USA, who believe it's due to mercury poisoning and all, you know, all sorts of things. 343 00:40:19,660 --> 00:40:23,870 And you just cannot accept that the notion. 344 00:40:23,870 --> 00:40:30,010 Well, OK, but let's try and help people using a psychological approach, 345 00:40:30,010 --> 00:40:34,700 because the implication they have is you're saying this is all in the mind, it's a mental disorder. 346 00:40:34,700 --> 00:40:45,160 I'm not saying that. You know, it's. Yeah. So how much time did you have to spend, say, going up to London to national bodies, international bodies? 347 00:40:45,160 --> 00:40:53,920 Um, quite a lot. And I still do. I mean, I got a lot on the National Suicide Prevention Advisory Group. 348 00:40:53,920 --> 00:40:57,700 I've been on that right since the beginning when we first developed the suicide 349 00:40:57,700 --> 00:41:03,580 prevention strategies during the Department of Health or the Department of Health. 350 00:41:03,580 --> 00:41:15,220 I've been on temporary Department of Health working groups on evidence based psychological therapies and a number of other things. 351 00:41:15,220 --> 00:41:25,720 I sit on the police Ekpo, the Association of Police Officers, now have a national suicide prevention strategy group. 352 00:41:25,720 --> 00:41:33,220 Um, and then I suppose a lot of the ad hoc meetings, um, one last week, 353 00:41:33,220 --> 00:41:38,810 Chief Medical Officer launching their annual report, which had written a Chapter four and so on. 354 00:41:38,810 --> 00:41:48,440 So yeah, I know. And when you went European with Proxima, did any of your liden friends help in that? 355 00:41:48,440 --> 00:41:55,850 So was that quite similar? No, that was separate. No, they weren't, um, they they weren't involved with. 356 00:41:55,850 --> 00:42:02,320 Did you get a Dutchman over here? Um, well, we had some visits. 357 00:42:02,320 --> 00:42:11,740 Interestingly, I'm just in the middle of arranging a clinical student from Leiden to come and work with us for, I think two or three months. 358 00:42:11,740 --> 00:42:16,300 Yeah, I and and he's got to do some research with us. 359 00:42:16,300 --> 00:42:23,740 So, I mean, it's good that that links continued. Um, so you were saying you've written a chapter of this national report. 360 00:42:23,740 --> 00:42:31,000 How much writing do you do? I mean, I spend my life writing, editing and writing books. 361 00:42:31,000 --> 00:42:36,190 And I mean, I did I used to have always had one or two books on the go. 362 00:42:36,190 --> 00:42:44,680 But I must say, I find them more of a struggle these days and haven't actually when I've got one in mind. 363 00:42:44,680 --> 00:42:54,670 But what sort of what I won on the psychology of suicide, which I would be really interested to bring in all the sort of psych, 364 00:42:54,670 --> 00:43:01,930 you know, the psychological components of suicidal behaviour and the psychological models. 365 00:43:01,930 --> 00:43:13,230 But whether I would do it or not, I'm not sure. And I we've got one on the shelf on media influences on suicide, which I'm afraid is half done. 366 00:43:13,230 --> 00:43:21,970 And it's been half done for rather a long while. But, um, that is so if somebody commits suicide, they'll say, well, I mean, we did it. 367 00:43:21,970 --> 00:43:32,680 We did a study back in ninety six, seven, I think it was looking at a casualty programme where the a paracetamol overdose. 368 00:43:32,680 --> 00:43:37,030 And that was in the days when Casualty had viewing figures or what. 369 00:43:37,030 --> 00:43:41,890 That particular one. We investigated our viewing figures. Twelve million. 370 00:43:41,890 --> 00:43:49,990 I mean it's unbelievable now that one programme that this chap took a paracetamol overdose, the implications were going to die. 371 00:43:49,990 --> 00:43:55,090 He's going to die. He had a haematoma. It's not very pleasant. 372 00:43:55,090 --> 00:43:59,440 And you think would put people off. And we were able we had such advanced warning, 373 00:43:59,440 --> 00:44:07,300 we were able to get a grant to do research on this because they weren't going to change the schedule, change the script. 374 00:44:07,300 --> 00:44:11,590 The script. Right. Did change a little bit with some advice from us. 375 00:44:11,590 --> 00:44:22,500 But and we got data from 43 hospitals and interviews with patients in 23 of those animals. 376 00:44:22,500 --> 00:44:30,340 And we are much to our surprise, we found that there was a very significant increase in paracetamol overdoses. 377 00:44:30,340 --> 00:44:38,080 I mean, it was in those who said they watched the programme and I've seen those who said they hadn't watched the programme. 378 00:44:38,080 --> 00:44:47,170 Um, and when asked specifically how it influenced you, I a very sound proportion said yes to that. 379 00:44:47,170 --> 00:44:54,190 And they chose the paracetamol because this and the impact lasted about two to three weeks is actually extraordinary. 380 00:44:54,190 --> 00:44:59,870 And and it's always cited now as a, you know, one of the. 381 00:44:59,870 --> 00:45:03,800 In a key piece of evidence in relation to TV programmes that they. 382 00:45:03,800 --> 00:45:08,300 Yes, I mean, you know, it has a perfect can have a profound effect. 383 00:45:08,300 --> 00:45:15,440 And then there was the famous room that when the doctors withdrew their services, the suicides went down. 384 00:45:15,440 --> 00:45:19,840 That's right. Well, there wasn't very good data on. 385 00:45:19,840 --> 00:45:27,890 Right. I think it was some London data suggesting that fewer people are presented and and so on. 386 00:45:27,890 --> 00:45:31,590 I mean, I honestly, I didn't think the data were very good. 387 00:45:31,590 --> 00:45:38,000 Okay. But, you know, it's interesting because, I mean, it raises the question, you know, 388 00:45:38,000 --> 00:45:48,440 when a person takes an overdose in the heat of an argument or something relationship or do they think about ending up in hospital knows the answer. 389 00:45:48,440 --> 00:45:53,390 So I'd be surprised if those data were accurate. Any of the hospitals. 390 00:45:53,390 --> 00:46:04,910 The last thing you're thinking of right now, if you look, it's difficult, but take the young man qualifying today and back in your time. 391 00:46:04,910 --> 00:46:10,910 How much is the sort of psychiatric awareness change, would you say? 392 00:46:10,910 --> 00:46:23,300 Well, I think it's improved. I mean, one of the problems is and I'm referring to what happens in Oxford at one time, 393 00:46:23,300 --> 00:46:31,070 we had a lot of teaching on the medical wards and we used to, you know, for example, to interview training. 394 00:46:31,070 --> 00:46:41,090 I mean, Tony, Hope is very involved with this is do interview training of students, which had a sort of emphasis on the psychological side. 395 00:46:41,090 --> 00:46:46,160 We had more much more teaching going on through the eyes on psychiatry. 396 00:46:46,160 --> 00:46:54,950 We used to run a few sessions a week with medical students when they're on medical terms, thinking about psychiatric aspect. 397 00:46:54,950 --> 00:46:59,930 Unfortunately, that's no longer happening. So. Well, stop there. 398 00:46:59,930 --> 00:47:08,570 What I don't know. I think it's just that, you know, the the pressure on the timetable has been, you know, probably the main issue. 399 00:47:08,570 --> 00:47:18,320 Um, I mean, I used to run a teaching day here on two days on sexual problems, 400 00:47:18,320 --> 00:47:26,930 getting clinical students to think about that aspect of people's problems and the impact of physical illness. 401 00:47:26,930 --> 00:47:31,190 And that no longer happens. So I don't know where they get training on that. 402 00:47:31,190 --> 00:47:35,750 But, of course, patients are going to present in primary care and so on with these problems. 403 00:47:35,750 --> 00:47:41,550 I mean, you know, whether they discuss them with the doctor or not. Yeah. And on with the underlying, you know, I mean. 404 00:47:41,550 --> 00:47:50,600 Exactly. So I would say things have improved in some ways and not in others. 405 00:47:50,600 --> 00:47:59,750 I think the stigma around mental illness is slowly shifting, but it's very much two steps forward and one step back. 406 00:47:59,750 --> 00:48:07,010 And I think some might near the recent death of Robin Williams makes people more aware of the impact of mental illness. 407 00:48:07,010 --> 00:48:16,530 But that can rapidly get countered by some newspaper headlines about, you know, that person goes on the rampage. 408 00:48:16,530 --> 00:48:21,590 And so and that I think, you know, students are affected by these things. 409 00:48:21,590 --> 00:48:28,370 But I think I think it all I think the crucial thing is what's happening in the general hospital, 410 00:48:28,370 --> 00:48:39,890 to what extent students see mental clinic psychiatric practise as being part of medical practise. 411 00:48:39,890 --> 00:48:44,150 I mean, I was talking to one of my clinical students the other day said, look after some students. 412 00:48:44,150 --> 00:48:48,410 College through which college? Greentown. Yeah, yeah. 413 00:48:48,410 --> 00:48:52,760 And he was saying it's fascinating. He said this is so different. 414 00:48:52,760 --> 00:48:55,580 You know, it was just it is I mean, it's very different. 415 00:48:55,580 --> 00:49:01,250 I mean, fortunately, he said some very positive things about how he's been looked after in psychiatry and, 416 00:49:01,250 --> 00:49:04,070 you know, welcoming people are and the opportunity you got. 417 00:49:04,070 --> 00:49:12,650 But you clearly see it in a very different and we're a long way from having that sort of integration. 418 00:49:12,650 --> 00:49:18,470 And I people are talking these days about how you come across this parity of esteem is the N word, 419 00:49:18,470 --> 00:49:27,110 which is which is about parity of resources and so on for mental health services. 420 00:49:27,110 --> 00:49:32,300 As for physical health services. And we're a long way from that. Yeah, yeah. 421 00:49:32,300 --> 00:49:42,680 And I think, you know, that the integration seeing things is more integrated is sort of crucial. 422 00:49:42,680 --> 00:49:49,100 But I think, you know, for example, I mean, I think in psychiatry, people, 423 00:49:49,100 --> 00:49:55,070 you know, I think there's not enough emphasis on the physical health of patients. 424 00:49:55,070 --> 00:49:58,980 So it's two sided. I think, uh. 425 00:49:58,980 --> 00:50:07,650 And I think sometimes people come into the country and almost certainly glad they're sorry, but they're not thinking all the time of, 426 00:50:07,650 --> 00:50:15,660 you know, physical explanation, might there be this person's anxiety disorder, you know, the right issues, et cetera. 427 00:50:15,660 --> 00:50:22,710 And so I think that's why but we don't seem to be very successful in getting that integration. 428 00:50:22,710 --> 00:50:27,270 Our enlistments book. Good book. Fantastic and lovely man. 429 00:50:27,270 --> 00:50:39,000 Yes, he was our best man over. But just to go back to the general scene is a little more selective in any way. 430 00:50:39,000 --> 00:50:51,480 The general adult psychiatry service has gone from there now as the numbers of inpatient psychiatric beds have been reduced nationally and of course, 431 00:50:51,480 --> 00:51:04,350 locally, we've now own the all the all the psychiatric inpatient service general services are here at the Walter Reed Hospital. 432 00:51:04,350 --> 00:51:12,180 But the but little more now. And of course, it's not the old hospital, it's the buildings over the road from the old hospital. 433 00:51:12,180 --> 00:51:19,200 Now, the main thing there is it's a major forensic centre, but I think it's 12 consultants and forensic psychiatrist. 434 00:51:19,200 --> 00:51:23,120 I had no know a huge friend because it was addiction at one time. Alcohol was. 435 00:51:23,120 --> 00:51:34,620 Yes, yeah. You know, unfortunately, alcohol has alcohol problems have now moved out of health and community and charity money, 436 00:51:34,620 --> 00:51:39,150 which I think is very wrong, very wrong, as you know, from working in General Hospital. 437 00:51:39,150 --> 00:51:42,640 I mean, an awful lot of the problems you see there are alcohol related. 438 00:51:42,640 --> 00:51:47,220 And of course, in the self harm population, it's a major, major issue. 439 00:51:47,220 --> 00:51:51,840 And we've shown that people are dying from alcohol. 440 00:51:51,840 --> 00:52:03,390 People are dying from alcohol. Problems relate who have been self harming a dying 30 over 30 years earlier than general population life expectancy. 441 00:52:03,390 --> 00:52:13,440 And it's it's a huge issue. And yet we don't even have an alcohol service in the general hospital these days, which is so wrong. 442 00:52:13,440 --> 00:52:19,590 Now, the developments here, I mean, do you think they've moved a bit towards the physical side? 443 00:52:19,590 --> 00:52:24,900 In other words, if you can damage the brain, will that give you the answer? 444 00:52:24,900 --> 00:52:30,570 I mean, in terms of research, yes, definitely. I mean, it's much more biological research. 445 00:52:30,570 --> 00:52:38,560 I mean, Michael Gallagher's successor, Guy Goodwin, it was is primarily a biological psychiatrists. 446 00:52:38,560 --> 00:52:47,220 So that was a huge influence in the in the shift. But I think the great thing about our department is it's retained. 447 00:52:47,220 --> 00:52:53,330 The full span that I talked about earlier, Michael girl that was keen on mean, 448 00:52:53,330 --> 00:53:01,590 I suppose you would be the most psycho social epidemiological end of psychiatry we've got. 449 00:53:01,590 --> 00:53:15,000 You know, psychology is very strong. Um, uh, other social psychiatry, prisons research got quite a big programme on that. 450 00:53:15,000 --> 00:53:18,870 But then a whole range of biological psychiatry. 451 00:53:18,870 --> 00:53:25,930 And we're now fortunate in that dementia research here is really taking on a very big way. 452 00:53:25,930 --> 00:53:32,730 And, um, so that's going to become a major, major focus. 453 00:53:32,730 --> 00:53:40,500 Good way, Goodwin. He's been succeeded. Yes. He's still in the department, but he stepped down as head of the department. 454 00:53:40,500 --> 00:53:50,970 John Kerry is now. What's his main interest? Well, I guess clinical trials is one of his main things. 455 00:53:50,970 --> 00:53:55,350 And he set up a clinical trials, research of medicines all. 456 00:53:55,350 --> 00:54:04,920 But he's got the whole range of the whole range medicines and psychological therapies and bipolar disorder, 457 00:54:04,920 --> 00:54:09,810 which is a very, very major strength in the field in this department. 458 00:54:09,810 --> 00:54:11,640 What have I asked you about that? 459 00:54:11,640 --> 00:54:25,020 I should have, um, uh, I guess you off the island about when I thought of the medical school and I said I enjoyed it. 460 00:54:25,020 --> 00:54:37,380 And I think one of the things that was so important then and afterwards for me was sport and, um, and that we you know, we're very strong on sport. 461 00:54:37,380 --> 00:54:44,580 As you know, we had our first year and I came as a non rugby player to the medical school, unfortunately. 462 00:54:44,580 --> 00:54:48,510 So I ended up loving rugby and started playing for them. 463 00:54:48,510 --> 00:54:55,950 And I remember for the medical school side, I remember our first year unbeaten and playing quite strong teams in those days. 464 00:54:55,950 --> 00:54:58,950 You were a three quarter. Yes. Yes, three quarter. 465 00:54:58,950 --> 00:55:10,860 And people people like Tony Fisher and, of course, the psycho pharmacologist and his name still around, right? 466 00:55:10,860 --> 00:55:17,160 Yes, I was recalled. Yes. And and of course, we had we had a that's time we had an all black trial, 467 00:55:17,160 --> 00:55:27,120 is scrumhalf that he's got a lot of point where he was pretty formidable to the board. 468 00:55:27,120 --> 00:55:31,260 So, I mean, we had a student who only came for a short while. 469 00:55:31,260 --> 00:55:37,560 I was under 40, failed the exam and had to we went up to a London medical school, which is more enlightened to take him. 470 00:55:37,560 --> 00:55:41,220 However, he played for Scotland on the wing and I remember his first game. 471 00:55:41,220 --> 00:55:48,990 He's got three tries in the first 20 minutes. But I mean, the minute the rugby was fantastic, Oliver wouldn't play in that. 472 00:55:48,990 --> 00:55:53,760 I know it's. And and then you played cricket at Cambridge, had you? 473 00:55:53,760 --> 00:55:57,900 I think I play cricket all the way through. I've always loved cricket. 474 00:55:57,900 --> 00:56:04,200 I started about age 11, played in Cambridge, didn't I didn't I wasn't up to university, 475 00:56:04,200 --> 00:56:09,000 you know, first team standard, but, you know, a good college cricket standard. 476 00:56:09,000 --> 00:56:15,990 And I came here and carried on playing and played until I was 63. 477 00:56:15,990 --> 00:56:23,920 Very good for me if gave up and and with the students playing cricket. 478 00:56:23,920 --> 00:56:27,720 Well, I don't know what I mean. This is one of the things in a sense, I was going to follow on. 479 00:56:27,720 --> 00:56:36,010 I mean, as you know, rowing's become a huge strength in the medical school, but I mean, not cricket. 480 00:56:36,010 --> 00:56:41,670 I don't know where they play. I mean, I was president of the cricket team and then it just sort of faded away. 481 00:56:41,670 --> 00:56:52,050 And I was really disappointed. And I think they do play occasionally and we no longer have staff student games like we used to have and stuff. 482 00:56:52,050 --> 00:56:56,100 I mean, rugby. I think it is pretty occasional. 483 00:56:56,100 --> 00:57:01,950 I think they cut us like part because where we used to play at one time. 484 00:57:01,950 --> 00:57:10,110 And I think it's interesting that I get the impression that what I would call the traditional sports, 485 00:57:10,110 --> 00:57:17,110 rugby and cricket or football, I think still, you know, very soccer. 486 00:57:17,110 --> 00:57:27,660 Yeah. But I think cricket and rugby and less people are doing other, more diverse things tennis, tennis, basketball, dancing. 487 00:57:27,660 --> 00:57:31,770 I mean, it's you know, it's very popular. 488 00:57:31,770 --> 00:57:38,610 And it was it's now a competitive sport. I mean, did you get into the Kendrick or. 489 00:57:38,610 --> 00:57:40,389 I was into Hendrick, yes.